From the Guidelines
The 2025 GOLD criteria recommend a stepwise approach to COPD medication management, prioritizing long-acting bronchodilators, such as LAMA or LABA, as initial therapy, with dual bronchodilation and addition of ICS for patients with persistent symptoms or exacerbations, as supported by the 2023 Canadian Thoracic Society guideline 1.
Key Recommendations
- Initial therapy for most patients should include a long-acting bronchodilator, either a long-acting muscarinic antagonist (LAMA) like tiotropium or a long-acting beta-agonist (LABA) like salmeterol.
- For patients with persistent symptoms or exacerbations, dual bronchodilation with both LAMA and LABA is recommended, with a step up to single-inhaler triple therapy in those with persistent moderate to severe dyspnea and/or poor health status despite treatment with single inhaler dual therapy with LAMA/LABA or ICS/LABA 1.
- Inhaled corticosteroids (ICS) should be added for patients with blood eosinophil counts ≥300 cells/μL or those with ≥2 moderate exacerbations or hospitalization in the past year despite optimal bronchodilator therapy.
Additional Considerations
- For frequent exacerbators despite triple therapy (LAMA+LABA+ICS), additional options include roflumilast (for those with chronic bronchitis and FEV1 <50%), azithromycin (250mg daily or 500mg three times weekly), or mucolytics like N-acetylcysteine (600mg twice daily) 1.
- The best option to alleviate dyspnea and other symptoms as well as to improve health status is to combine optimal pharmacotherapy with pulmonary rehabilitation.
Prioritization of Outcomes
- The 2025 GOLD criteria prioritize reducing symptoms and exacerbations while minimizing side effects, with bronchodilators targeting airway smooth muscle relaxation and anti-inflammatory medications addressing the underlying inflammatory process in COPD.
- The recommendations aim to improve health status, reduce mortality, and prevent acute exacerbations of COPD (AECOPD), with a focus on individualized treatment based on symptom burden and exacerbation risk.
From the Research
2025 GOLD Criteria for Medications
The 2025 GOLD criteria for medications in the treatment of chronic obstructive pulmonary disease (COPD) and asthma are not directly addressed in the provided studies, with the exception of study 2, which discusses the 2024 edition of guidelines for the prevention and management of bronchial asthma.
- The study 2 provides recommendations for the treatment of asthma, including the use of inhaled corticosteroids (ICS), long-acting beta2-agonists (LABA), and combination therapies.
- Recommendation 13 from study 2 states that ICS-LABA demonstrate synergistic anti-inflammatory and anti-asthmatic effects, achieving efficacy equivalent to or better than doubling the ICS dose.
- Recommendation 14 from study 2 suggests that triple combination inhalers can be prescribed to improve symptoms, lung function, and reduce exacerbations when asthma remains uncontrolled on medium- or high-dose of ICS-LABA.
- However, it is essential to note that these recommendations are for asthma management and may not directly apply to the 2025 GOLD criteria for COPD medications.
COPD Medications
Studies 3, 4, 5, and 6 discuss the treatment of COPD with various medications, including:
- Salmeterol and fluticasone propionate (SFC)
- Tiotropium bromide (TIO)
- Ipratropium bromide and albuterol
- These studies provide evidence for the effectiveness of these medications in improving lung function and symptoms in patients with COPD.
Limitations
- The provided studies do not directly address the 2025 GOLD criteria for medications.
- The studies primarily focus on asthma and COPD treatment, with limited information on the specific guidelines for 2025.
- Further research and guidelines are necessary to determine the most up-to-date and effective treatment options for COPD and asthma, as recommended by the 2025 GOLD criteria 2.